Disseminated Cutaneous Varicella Zoster Virus Infections During Infliximab Therapy for Crohn’s Disease: Case Report of Two Pediatric Patients at One Institution

Infliximab is a monoclonal antibody against tumor necrosis factor-a (TNF-a) that has been approved for the treatment of rheumatoid arthritis and Crohn’s disease. It is used in steroid-sparing regimens for patients who have had an inadequate response to conventional therapy. There are a number of studies that have shown an increased risk of infections with bacteria, fungi, mycobacterium, and more recently, chronic viral infections in patients receiving TNF-a antagonists. We report 2 cases of pediatric patients on infliximab therapy for Crohn’s disease who presented with disseminated cutaneous varicella zoster and primary varicella infections. Despite prompt and appropriate antiviral therapy both patients continued to manifest clinical findings of varicella zoster virus (VZV) infection and ultimately required hospitalization.